Policy progress for physician treatment of opiate addiction

Merrill, Joseph O.

doi:10.1007/s11606-002-0041-6

Cited by 46 publications

(14 citation statements)

References 47 publications

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“…The approval of buprenorphine may promote new officebased strategies involving primary care physicians or public health clinics that could further benefit some individuals. 56 The recent shift to accreditation may also encourage providers to more carefully monitor the quality of services they provide. It will be important to examine state databases over the coming years to see if any of these efforts have a measurable impact on retention rates.…”

Section: Implications For Behavioral Healthmentioning

confidence: 99%

Retention in publicly funded methadone maintenance treatment in two western states

Deck

Carlson

2005

The Journal of Behavioral Health Services & Research

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This study examined individual and system characteristics associated with retention in methadone maintenance treatment among Medicaid-eligible adults in treatment for opiate use in Oregon and Washington. Logistic regression was used to examine the contributions of predisposing, need, and enabling characteristics on 365 day retention in methadone maintenance treatment. Older patients, patients with a history of methadone maintenance treatment, and persons with stable Medicaid eligibility had higher rates of retention than did patients with disabilities, polysubstance users, and those with an arrest record. In Oregon, which delivers methadone maintenance treatment through managed care, retention rose sharply from 28% to 51% between 1994 and 1998 and then leveled off. During the same time period, retention in Washington State grew from 28% to 34%. The higher rates of retention in Oregon, in part, can be explained by differences in service delivery influenced by financing. Faced with long waiting lists, Washington providers were more than twice as likely to administratively discharge patients for rule violations as their Oregon counterparts. Given the importance of retention, policies and practices that influence retention should be carefully considered. Because Medicaid eligibility has a dramatic impact on retention, policies that help extend eligibility or stabilize eligibility among individuals actively engaged in treatment should be carefully considered.

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Section: Implications For Behavioral Healthmentioning

confidence: 99%

Retention in publicly funded methadone maintenance treatment in two western states

Deck

Carlson

2005

The Journal of Behavioral Health Services & Research

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“…The most commonly prescribed formulation of buprenorphine, in which it is combined with the opiate antagonist naloxone, produces opiate withdrawal when injected, limiting its abuse potential 5 . Because of these lower risks, buprenorphine can be prescribed by office-based generalist physicians, potentially increasing treatment access and reducing stigma in comparison to methadone 6 , which is restricted to federally regulated methadone clinics.…”

Section: Introductionmentioning

confidence: 99%

Variation in Use of Buprenorphine and Methadone Treatment by Racial, Ethnic, and Income Characteristics of Residential Social Areas in New York City

Hansen

Siegel

Case

et al. 2013

J Behav Health Serv Res

169

118

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National data indicate that patients treated with buprenorphine for opiate use disorders are more likely to be White, highly educated, and to have greater incomes than those receiving methadone, but patterns of buprenorphine dissemination across demographic areas have not been documented in major metropolitan areas where poverty, minority populations and injection heroin use are concentrated. Rates of buprenorphine and methadone treatment are compared among areas of New York City defined by their income and ethnic/racial composition. Residential social areas (hereinafter called social areas) were defined as aggregations of ZIP codes with similar race/ethnicity and income characteristics, and were formed based on clustering techniques. Treatment rates were obtained for each New York City ZIP code: buprenorphine treatment rates were based on the annual number of buprenorphine prescriptions written, and the methadone treatment rate on the number of methadone clinic visits for persons in each ZIP code. Treatment rates were correlated univariately with ethnicity and income characteristics of ZIP codes. Social area treatment rates were compared using individual ANOVA models for each rate. Buprenorphine and methadone treatment rates were significantly correlated with the ethnicity and income characteristics of ZIP codes, and treatment rates differed significantly across the social areas. Buprenorphine treatment rates were highest in the social area with the highest income and lowest percentage of Black and Hispanic residents. Conversely, the methadone treatment rate was highest in the social area with the highest percentage of low income and Hispanic residents. The uneven dissemination of 0pioid maintenance treatment in New York City may be reflective of the limited public health impact of buprenorphine in ethnic minority and low income areas. Specific policy and educational interventions to providers are needed to promote the use of buprenorphine for opiate use disorders in diverse populations.

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“…It would be naïve to regard this as a straightforward process; adequate training of the healthcare workers who prescribe such treatments is crucial given the ever-broadening range of potential maintenance treatments and different approaches to treatment. In many countries, opioid-dependent patients are being treated not only in special addiction clinics, but by physicians in the primary care setting [36][37][38][39] . Using properly trained personnel with an awareness of the therapeutic options, this should increase the number of patients who can receive treatment and magnify the number gaining benefi t.…”

Section: Discussionmentioning

confidence: 99%

Use of Slow-Release Oral Morphine for the Treatment of Opioid Dependence

Kraigher¹,

Jagsch

Gombas

et al. 2005

Eur Addict Res

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Aims: In addition to methadone, other synthetic opioids are now available for the treatment of opioid dependence. The study investigated the treatment satisfaction of oral slow-release morphine for maintenance therapy in opioid-dependent patients in an open-label 3-week study. Design: We evaluated the treatment satisfaction of oral slow-release morphine hydrochloride for 3 weeks in 110 patients meeting the diagnosis of opioid dependence (DSM-IV 304.0) or polysubstance dependence (DSM-IV 304.9). Measurements: Primary outcome measures were the study retention rate, urinalysis for additional illicit consumption other than heroin, cravings and withdrawal symptoms 24 h after the last intake of the medication (duration of action of treatment). Findings: In total, 103 patients completed the study, representing a retention rate of 94%. Patients reported significant improvements in somatic complaints, as well as significant reductions in heroin and cocaine cravings (p < 0.0001) and in additional consumption of cocaine in supervised urinalysis (p = 0.0083). Additional illicit consumption of benzodiazepines remained unchanged. Conclusions: The high study retention rate implies a good acceptance of slow-release acting oral morphine. However, randomised, double-blind, double-dummy studies with a longer investigational period are needed to meet criteria for evidence-based medicine.

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Policy progress for physician treatment of opiate addiction

Cited by 46 publications

References 47 publications

Retention in publicly funded methadone maintenance treatment in two western states

Retention in publicly funded methadone maintenance treatment in two western states

Variation in Use of Buprenorphine and Methadone Treatment by Racial, Ethnic, and Income Characteristics of Residential Social Areas in New York City

Use of Slow-Release Oral Morphine for the Treatment of Opioid Dependence

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